We sought to determine if the rate of cefazolin use for antimicrobial prophylaxis could be increased in elective surgical patients with a reported β-lactam antibiotic allergy with the use of a simplified questionnaire and without of skin testing. We conducted a quality improvement intervention at University Health Network, Toronto, ON, Canada by adapting a novel allergy assessment tool, the Modified Allergy Clarification for Cefazolin Evidence-based Prescribing Tool (ModACCEPT), which uses history alone to determine the safety of using cefazolin among patients with a self-reported β-lactam antibiotic allergy (SRBA) in the absence of skin testing. Prior to this, we performed knowledge dissemination campaigns to the surgical divisions and anesthesiology to communicate the safety of this approach. We used an interrupted time series analysis to determine the impact of the intervention on the proportion of patients with SRBA receiving cefazolin perioperative prophylaxis. Historic electronic data determined the stable rate of cefazolin administration within the institution at 28
ObjectiveCognitive impairment is increasingly recognized in patients with cerebral venous congestion (CVC), yet the cognitive tools used are largely adapted from stroke and dementia research. This review examines current literature on cognitive function in CVC, including conditions such as cerebral venous sinus thrombosis (CVST), idiopathic intracranial hypertension (IIH), and dural arteriovenous fistulas (dAVFs). Special emphasis is placed on the limitations of common screening tools like the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). Cognitive dysfunction-primarily affecting executive function, processing speed, and attention-is reported in up to 86% of CVC cases, yet only about 20% of studies use validated cognitive testing tools, most of which may lack sensitivity for CVC-specific deficits. Emerging techniques such as ocular motor testing and physiological markers show promise but require further validation. There is an urgent need for standardized, CVC-specific cognitive assessment protocols that reflect the unique pathophysiology of venous disorders. Future research should prioritize the development of targeted cognitive batteries and integrate objective physiological measures to enhance diagnostic accuracy.
Gastric point-of-care ultrasound (POCUS) may offer clinical value in assessing aspiration risk among medically complex patients undergoing regional anesthesia and pain procedures. While the American Society of Anesthesiologists (ASA) preoperative fasting guidelines primarily apply to healthy individuals, medically complex populations often present with differing gastric emptying and aspiration risk. This narrative review, conducted by the American Society of Regional Anesthesia and Pain Medicine (ASRA-PM), adhered to PRISMA guidelines and was registered with PROSPERO. It focused on seven medically complex patient groups: those who are pregnant, obese, diabetic, have gastroesophageal reflux disease (GERD), are receiving emergency care, are enterally fed, or are taking GLP-1 receptor agonists (GLP-1RA). Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Practice recommendations were developed using an iterative expert consensus process, with final recommendations based on evidence strength, clinical relevance, and expert agreement. Findings support the use of gastric POCUS in patients in active labor, those undergoing urgent cesarean sections, and those with diabetes. Conditional support is given for obesity, emergency care, enteral feeding, and GLP-1RA use. Routine use is not recommended in non-laboring pregnancies, elective cesarean delivery, or GERD. While gastric POCUS may aid with aspiration risk evaluation, its use should complement clinical judgment. Implementation may be limited by practical and training constraints, requiring individualized decision-making. These recommendations serve as a foundation for future research and potential clinical guideline development. PROSPERO registration number: CRD42023445927.
Parkinson's disease (PD) is increasingly recognized as a heterogeneous neurodegenerative entity with diverse clinical presentations, genetic contributors, and neuropathological features. Central to its pathogenesis is misfolded and aggregated α-synuclein, which collectively form Lewy pathology. Recent advances in biomarker and genetic research have enabled biologically grounded models of PD classification, diagnosis and staging. This review summarizes key principles, differences, and ongoing challenges of two emerging research frameworks: the SynNeurGe criteria and the Neuronal α-Synuclein Disease Integrated Staging System (NSD-ISS)-the former proposed a biologically based classification, while the latter proposed a more restrictive biological definition and staging schema. SynNeurGe incorporates synucleinopathy (S), neurodegeneration (N), genetic risk (G) and clinical status (C) to classify etiologic subtypes across the disease spectrum, emphasizing clinical heterogeneity and multifaceted underlying biological processes. In contrast, the NSD-ISS defines "neuronal α-synuclein disease" (NSD) based on specific molecular (S) and dopaminergic dysfunction (D) markers and a single genetic anchor (SNCA) (G), and maps disease progression across seven clinical stages. While both aim to improve early detection and to advance PD research, they differ in scope, operational definitions, implementation principles, and intended applications. Prevailing challenges include current limitations in mechanistic insights, biomarker standardization and accessibility, underrepresentation of genetic diversity, and ethical considerations around disease labeling and risk disclosure, particularly in asymptomatic cases. These frameworks represent a pivotal shift toward biologically based concepts of PD and related disorders, with future success contingent on continued refinement, validation, and equitable implementation.
Purpose:Nystagmus involves abnormal head positions (AHPs) toward the null point for improving visual acuity. While surgical interventions are the standard therapy, the use of yoked prisms is a possibility not often used. Our team used low-value prisms in children to mitigate AHP. Methods:Yoked prisms were tailored to the direction of head turn. Thirty-one children were reviewed. Outcomes were binocular best-corrected visual acuity (BBCVA) and AHP measures with and without prisms. Results:Of the 31 patients aged 10.3 ± 3.6 years (16 male), 19 were diagnosed with idiopathic infantile nystagmus syndrome, 6 with oculocutaneous albinism, and 6 with other secondary nystagmus. Prism's average prescription was 3.9 ± 1.25 diopters. BBCVA for distance averaged 0.44 ± 0.22 logMAR, improving to 0.41 ± 0.23 logMAR (P = 0.001, small size effect). AHP reduced from 16.9° ± 9.9° to 4.6° ± 5.8° for distance vision (P < 0.0001) and 12.7° ± 12.9° to 3.8° ± 6.2° for near vision (P < 0.0001), both with large size effects. The angle of the prisms most frequently prescribed was 180° (26 cases), as well as 2 cases at 135°, 1 case at 30°, and 2 cases at 90°. Discussion:Our study found an improvement in AHP using low-value prisms in a pediatric population with nystagmus. Allowing the use of primary gaze position, prisms may be a therapeutic option to reduce the physical and social difficulties from AHP in these cases. Conclusions:This study provides the first quantitative assessment of the minimal prism values required to significantly reduce abnormal head posture in nystagmus, offering a valuable adjunctive treatment option for these patients.
